Though childish songs make crude jokes, there’s nothing funny about diarrhea. Aside from the painful, twisting feeling in your guts, there’s just something psychologically upsetting about losing control of your bowels. It’s embarrassing. It’s disgusting. And we’ve all been there.

Micrograph of C. difficile bacteria from a stool sample culture

But for many, diarrhea is more than a shameful stain to be washed away in an impromptu laundry load; in the US alone, more than 500,000 suffer and 15,000 die every year from uncontrollable diarrhea caused by infection with Clostridium difficile. These rod-shaped bacteria are commonly found in the environment and even in our bodies, but have lately become a major concern in hospitals where antibiotics leave patients without the natural flora that protect their bodies. When C. difficile populations grow unchecked, toxins produced by the bacteria cause inflammation and cell death, leading to the explosive symptoms that, if not controlled, can lead to severe dehydration, kidney failure, holes in the intestines and death. Patients already weakened by other illnesses are particularly at risk of succumbing. Epidemics of C. difficile have become such a serious problem that the infection now rivals the superbug MRSA as one of the top emerging disease threats.

A diagram of how a stool transplant is performed

With more and more strains of C. difficile becoming resistant to antibiotics, doctors have had to find creative ways to treat the infection. One of the most promising (if not revolting) treatments that has been tested in recent years is called fecal bacteriotherapy or ‘stool transplant’, which involves taking donor poop from a healthy patient and inserting it into the gut of an infected one as a form of probiotics, seeking to replace the protective flora. I wish I was kidding. The procedure involves collecting crap from a close relative that has been screened for other microbial pathogens, mixing it with saline or milk until it reaches the right consistency, and then placing it directly in the patient’s digestive system through a tube inserted either up the anus or down from their mouths. Though it might sound gross, the dose of healthy, helpful bacteria has shown to be very effective.

Of course, most patients aren’t exactly thrilled with the suggestion of shoving someone else’s bowel movements up their rectums or down their throats. Now, University of Guelph researchers have developed a more sanitary way of achieving the same results: synthetic poop.

The researchers created fake feces, aptly named RePOOPulate, after careful examination of bacterial colonies grown from the stool of healthy volunteers. Once the right ratio of species was determined, 33 different bacteria were grown in a robotic intestine simulator affectionately called Robo-gut to create a ‘super-probiotic’ stool substitute. According to the scientists, the bacterial mixture is much more palatable than what it mimics, and smells significantly better. Two patients treated with RePOOPulate showed marked improvement after three days, remaining C. difficile-free months after treatment. Tests of their intestinal flora showed that the fake crap successfully introduced beneficial bacteria to the patients’ guts.

It’s hard to say exactly how effective the new treatment is off of such a small test, but the results are very promising. Because scientists can control the bacterial mixture in RePOOPulate, there is less risk of introducing potentially harmful bacteria than with regular stool transplants, and the treatment can be tweaked to meet the needs of different patients. This proof-of-concept paper opens the doors for future testing. In time, RePOOPulate may prove a safe and effective treatment for C. difficile infection, as well as other gut diseases caused by the imbalance of beneficial bacteria like inflammatory bowel disease.

About the Author: Christie Wilcox is a science writer and blogger who moonlights as a PhD student in Cell and Molecular Biology at the University of Hawaii. Follow on Google+. Follow on Twitter @NerdyChristie.

4 Comments

I suppose it’s good news that a synthetic version of healthy feces is being developed, but I have a feeling this won’t be nearly as effective as using the real thing. It’s like breast feeding vs. bottle feeding. It is a disappointment that so many people react “yeeew, gross” at the thought of this procedure. In fact, it is a brilliant idea — it’s a simple, low cost, low risk solution — and it WORKS! If you’ve ever taken care of a patient with c-diff (at least for nursing), we aren’t talking about a little loose stool that you can swipe clean and go about your day. We are talking about huge ponds of a pungent diarrhea that gets all over the side rails, drips off the bed all over the floor, covers the patient from head to toe, and is very contagious. It is not only possible but probable that someone will leave the “code brown” and spread it to the patient next door, EVEN if you do wash your hands! Clean up requires an entire bed bath and sheet change (usually with the unconscious person still in the bed, and a clean up of the bed rails, floor, what ever you can do. (Keep in mind that the patient likely has sterile dressings that also get covered in the stuff, increasing the chances of a blood stream infection (sepsis). And with C-diff, it is not unusual to repeat this routine a dozen times during your shift, makes it hard to get much else done. Also, lying in poop unconscious greatly increases the chance that the patient will develop a bed sore, sounds like a small thing, but it can be a big problem. At the very least, think of the nurses and nurses aides (if you are lucky enough to have one)backs! And oh, yes, there is one more alternative to having a fecal transplant: having a rectal tube. Yes, a big tube stuck “up there” which may do permanent damage to your anal sphincter. Our patients aren’t allowed to wear diapers because of the bed sore risk. So, I hope everyone will think twice about dismissing the fecal transplant as “too gross.” Give me a fecal transplant — the real stuff — over the rest anytime!

@ aidel
Not that I ever belittled the vocation of nursing, but your comment makes one appreciate the work nursing staff do. I doubt that I would have the fortitude to “stomach” this sort of work. I go out in the garden with long handled pooper scoopers and cleanup after the dogs, and afterwards I feel decidedly queasy. Of course for the patient, the administering of the “poop” is only a minor indignity.

Steve, sometimes. Many animals eat other species’ feces (oh, the poetry possibilities) because it contains undigested nutrients. As far as I know, gut bacteria tends to be species-specific, so they’re probably not getting much benefit there.

Some animals eat their own species’ feces to benefit from the bacteria, particularly when they’re young. There’s also some potential benefit from nutrients in that situation, as well. Some foods just need more than one pass through the old digestive track.